High narcotic use among headache sufferers

A new analysis of nearly 6.2 million insured patients shows that migraine was under diagnosed and often untreated.

Also concerning, was that when patients were diagnosed with migraine and prescribed a medication, more than half received narcotics and opioid analgesics, which are not approved for the treatment of migraines, instead of triptans, which are migraine-specific medications.

The use of narcotics and opioid analgesics may lead to loss of productivity, carry a greater risk of medication overuse headaches (also known as chronic daily headaches or rebound headaches), and have the potential for abuse and dependency.

The analysis, published in the March issue of Headache and Pain: Diagnostic Challenges, Current Therapy, showed that of the patients diagnosed with migraines (n=148,825), only 50 percent received a prescription medication commonly used to treat headaches; of those, 59 percent received narcotics/opioids while only 41 percent received triptans. Because triptans have been available since 1993, this higher use of narcotics and opioids for migraine is surprising as they are not approved by FDA for migraine treatment. Furthermore, the widespread availability of multiple triptans has not lead to the expected decline in use of narcotics and opioids for migraine.

The analysis also suggests a high incidence of under-diagnosis and/or misdiagnosis of migraine. Nationally, approximately 12 percent of people suffer from migraines; however, in this data set, only 3 percent of subjects had a diagnosis of migraine, much lower than the national prevalence level. Therefore, the analysis confirms that there is a need for greater education and awareness of migraine.

"This analysis shows that in addition to the millions of migraine sufferers who are undiagnosed, the majority of people who are diagnosed are not receiving migraine-specific treatments," said Stewart J. Tepper, MD, director of The New England Center for Headache and lead author of the analysis. "This is unfortunate, because there are effective and generally well-tolerated treatments available, such as triptans, that are approved to treat migraine."

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